Provider Demographics
NPI:1558015263
Name:DRIESSEN, MEGAN JO (PHARMD RPH)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:JO
Last Name:DRIESSEN
Suffix:
Gender:F
Credentials:PHARMD RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 HAARFAGER AVE N
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:MN
Mailing Address - Zip Code:56220-1045
Mailing Address - Country:US
Mailing Address - Phone:507-828-2798
Mailing Address - Fax:507-223-5696
Practice Address - Street 1:130 SAINT OLAF AVE N
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:MN
Practice Address - Zip Code:56220-1372
Practice Address - Country:US
Practice Address - Phone:507-223-5955
Practice Address - Fax:507-223-5696
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist